En español | Testing women to catch ovarian cancer in its early stages would seem to make perfect sense. Rare and hard to detect, the disease has often spread to other organs by the time it's diagnosed — one reason that 15,500 women will die of ovarian cancer this year.
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But a new advisory from the U.S. Preventive Services Task Force recommends against routine screening of most symptom-free women, saying that while the case for catching the disease early is compelling, screenings can lead to unnecessary operations with high complication rates.
The reason, says task force chair Virginia A. Moyer, M.D., is that the two main methods used to diagnose ovarian cancer — transvaginal ultrasound scans and blood tests for a biomarker called cancer antigen-125 — yield a large number of false-positive results.
Only abdominal surgery can rule out the possibility of cancer, a major procedure that carries a small but real risk of complications, says Moyer, a professor of pediatrics at Baylor College of Medicine in Houston. "The downstream effects of all the false positives greatly outweigh the benefits," she says.
The recommendation, which reinforces the task force's guidelines first issued in 2004, does not apply to women who have specific symptoms, or to those with a family history or known genetic mutations predisposing them to the ovarian cancer, Moyer emphasizes.
The task force, an independent panel of medical experts appointed and funded by the federal Agency for Healthcare Research and Quality, regularly reviews the scientific basis for preventive measures such as cancer screening.
Its recommendations are sometimes controversial. In recent years it has cautioned against routine mammography for women under 50 and against prostate-specific antigen (PSA) tests for prostate cancer.
But the ovarian cancer guideline "simply is not controversial," Moyer says. "There's no one who thinks that this works."
When ovarian cancer symptoms do appear, they tend to be vague, but researchers at the Fred Hutchinson Cancer Research Center in Seattle have developed a simple three-question survey that may help distinguish ovarian cancer from other conditions — and perhaps spot it early enough for a cure.
The paper-and-pencil quiz, which can be delivered in a doctor's office, asks whether a woman has abdominal or pelvic pain, whether she feels full quickly or is unable to eat normally, and whether she has experienced abdominal bloating. The questionnaire also asks about the frequency and duration of the symptoms.
In a recent study of 1,200 women ages 40 to 87, 5 percent of the women who took the test had a positive score that called for further testing. Of this group of about 60 women, one was diagnosed with ovarian cancer. Meanwhile, none of the 95 percent of the women who tested negative on the symptom questionnaire developed ovarian cancer in the following 12 months.
"There does appear to be a substantial group of women who have symptoms at an early stage, when treatment can be effective," says M. Robyn Andersen, a senior cancer center epidemiologist who led the study. "If they can get it at an early stage, ovarian cancer is almost as treatable as breast cancer."
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